Learning from an integrated care organisation

Where next for commissioning and integrated care: Can the NHS rise to the challenge?, The Kings Fund

Dr Lucy Moore CEO Whipps Cross University Hospital TrustConor Burke, Borough Managing Director

March 2010

Decommissioning -• 20% of OP• 6% Electives

Shift Acute Activity -• 40% A&E• 12% Electives• 42% OP

Prevent -• 35% LTC Adms

Acute Quality -• Weak & Weak AHC• ↑Mortality• ↓Patient Experience

3

Real improvement comes from changing systems, not changing within systems.

Donald BerwickPresident & CEOInstitute for Healthcare Improvement

4

5

As an integrated local healthcare delivery network ‘PolySystems’ will:

Promote the health & wellbeing of all people in

the local community

Maximise Independence & quality of life for people with

long-term needs

Improve service for people with non-critical acute care

needs

Achieving improved health outcomes overall and for specific communities e.g.

• Childhood obesity

• Teenage conception

• Physical activity

• Reduce emergency admissions• Care Navigation & Coaching• Improved care coordination & dmanagement • Better quality of life measures• Reduced cost per head

• Reduced waiting RTT

• Improved patient satisfaction

• Better value for money

• Increased Access

6

Everybody in Redbridge is already a member of a polysystem

5 established - the engines driving change at a local level – delivering local services that are clinically and cost effective.

Loxford Polysystem

7

Delivering Change…

8

Focusing on CHD

9

10

11

12

And so what?

•Whipps Cross fax discharge summaries to practices within 24 hours of discharge •GP Practices are required to contact the patient within 3 days of discharge •Patients have a face to face appointment within 10 days at which time the clinician will use a standardised checklist to review patients.•Clinicians have access to data on a patients treatment, diagnostic results and medication changes via email.

….currently getting it right 50% of the time after 2 months

13

Underpinned by Aligned Data

Aligned and patient focused data for primary and secondary care data across the PCT

Risk StratificationComputes patient risks Provides “risk aware” analysis tools for GP and PCT staff

Pathway focus and financial tracking

GP Systems

PCT Databases

SUS records

Stratify DataWarehouse Journal entries

Users

• Practice Managers• Polysystem Managers• PCT Staff

Community Records

CommunityServices Records

GP Systems

PCT Databases

SUS records

Stratify DataWarehouseStratify DataWarehouse Journal entries

Users

• Practice Managers• Polysystem Managers• PCT Staff

Community Records

Community Records

CommunityServices Records

www.health-analytics.co.uk

14

Information Driving Change at all Levels

15

Delivering Improvement…...through People, Processes and Technology

Comm Nursing, AHPs Pharmacists, Social CareC

onsu

ltant

sSp

ecia

list C

are

GPs

One inclusive Polysystem Budget with pathway at cost

Collaborative and Competitive incentives

Estate development –transformational change

Underpinned by data - Combined productivity and quality measures

……Clinical Integration

16

The Acute Provider perspective

Key incentives• Better patient experience.

• Better supports the management of capacity.

• Reduces waste and duplication.

• Integrated delivery without changing structures.

Risks• Financial ….but we have a burning platform for change together.

• Governance…addresses issues rather than creates issues.

Thank You for Listening